Understanding and Treating Tinnitus and Vertigo | HealthCasts Season 3, Ep. 5

[Music] from sarasota memorial this is healthcast a healthy dose of information from experts you can trust hi everyone welcome to healthcast i'm alison gottermeyer thank you so much for joining us today as we discuss vertigo and tinnitus and treatments available right here at sarasota memorial our guest today dr jack wazon who is the chief of staff and medical director of otolaryngology head and neck surgery at sarasota memorial dr wazin thank you so much for joining us thank you so dr wazin an important question to just start this conversation of course is what is vertigo vertigo is the sensation of movement typically a spinning sensation you feel like you're on a merry-go-round it comes suddenly and it comes typically with a feeling of nausea and loss of equilibrium it could last for seconds two minutes to hours to days so what is the difference exactly between vertigo dizziness imbalance i know these get interchanged quite a bit that is true and it's very important to determine the exact nature of the symptom so that we could provide our patient with the right testing the right examination and the right diagnosis and the right treatment so as i said vertigo is that spinning sensation dizziness is a feeling of lightheadedness almost fainting sensation giddiness in the head patients tend to specifically say yes i have spinning i have vertigo or not it's easier to describe vertigo because of that spinning sensation it's more difficult to describe dizziness or lightheadedness everyone describes it in their own vocabulary but it is not the sensation of spinning and that's an important differentiation in the cause of symptoms and the other type of symptom that we talk about is called disequilibrium or imbalance and in those individuals say i'm fine if i'm sitting down i'm fine in bed if i'm not moving i'm okay it's when i get up to walk that i feel like i'm walking like a drunk or i cannot walk a straight line or i need to hang on to somebody so these are three different categories of balance disorders vertigo dizziness disequilibrium that are diagnosed differently and treated differently so what testing is necessary to determine vertigo versus imbalance or dizziness vertigo is typically an inner ear symptom so when somebody says i have episodes of vertigo with periods of normalcy in between you're thinking mainly in inner ear disorder of course there are brain disorders that could also cause vertigo but the majority of vertigo is inner ear based when we look at dizziness it could be anything it could be low blood sugar low blood pressure uh poor circulation in the brain inner ear problems so the diagnosis or the testing and the workup for general dizziness is much more extensive and complex than just vertigo where we could test the inner ear systems per se and of course the equilibrium this equilibrium condition also requires a more detailed workup because it could be inner ear problems could be brain problems or it could be musculoskeletal problems meaning joint issues arthritic issues uh spinal cord issues and so on how common is vertigo itself vertigo is very common actually the most common type of vertigo which you know almost everybody gets at one point or another is called positional vertigo benign positional vertigo and that's vertigo that happens when you look up to get something from a high shelf bend over to the floor or when you lie down [Music] put your head on the pillow or go to a doctor for a physical exam they put you down or go for to get a scan you lie down and the whole room spins and it spins for a few seconds and then it stops and it will spin again when you change your position again it's called benign positional vertigo and it's due to floating crystals in the inner ear fluids where typically they do not belong we all have crystals they sit in a chamber in the inner ear to give our brain the sense of gravity when they fall off base and they float in the fluid they cause positional vertigo that's very common and it is easily treated most people respond very quickly with certain maneuvers to reposition those crystals where they belong so what causes all of vertigo because there are other types of vertigo as you mentioned and and how can it be treated well vertigo is a symptom it's not a disease it's a symptom that something is not right so i said positional vertigo is one type of vertigo that is due to floating crystals another common type of vertigo is called meniere disease meniere disease more severe vertigo it lasts for minutes to hours and the attacks are stronger they last and they cause nausea vomiting in severe cases they could also cause diarrhea you cannot walk if you're having an attack of vertigo like this you're you're down you're in bed or you're on the floor or you're crawling to the bathroom because of the vomiting that it produces meniere disease is an inner ear disease it's not just vertigo it also includes loss of hearing in one or both ears typically one fullness and pressure in the ear and tinnitus which is the ringing or buzzing in the ear and it comes in attacks it's recurrent so you get the attack it lasts whatever attack it lasts and then it stops you could be better in a day or two you could be fine for a month or a year or a week and it could happen again it's unpredictable when it can happen again those are inner ear disorders meniere disease due to increased inner ear pressure from fluid buildup in the inner ear compartment we diagnose it with hearing testing and balance testing and we treat it with medications to reduce the fluid buildup and medications to suppress the vertigo in some instances about 20 30 percent of the time medications may not be enough to control many hair disease and that's when we use procedures on the ear and they could be either simple office procedures like injection of material in the ear or operating room procedures to stop the vertigo the myth is that if you have meniere's disease there's no cure and there's nothing that can be done and that is wrong because we can stop the vertigo from meniere disease using a multitude of options you spoke about the medical treatments are there any lifestyle changes which can also improve vertigo symptoms yes i'm glad you asked because particularly with meniere disease stress is a big factor so stress management is important diet is a big factor we want the patient to be on a low salt diet to decrease the fluid buildup in the ear low caffeine no smoking low alcohol these are all dietary and lifestyle changes and there are things that can precipitate these attacks that we have no control over such as changes in the weather on a rainy stormy day like our typical florida afternoons a meniere ear gets activated and you the patient will feel the pressure build up in the ear because of the change in atmospheric pressure you spoke about the relationship between vertigo and hearing loss when you look at someone with the hearing loss as well as the vertigo when you when they get those treatments does that help with the hearing loss as well so the treatment is going to address both the hearing loss and the vertigo the and the tinnitus hopefully the tinnitus is the most stubborn of all the symptoms um now sometimes we use hearing aids as well and sometimes we use implants so just to clarify for people who are unaware can you explain what tinnitus is tinnitus is the perception of sound in the ear you hear a sound that is not coming from an external source it's internal nobody else is hearing it it could be ringing it could be buzzing it could be a pure tone it could be multiple tones it is not speech or music if you're hearing somebody's talking to you or you're hearing musical elements that is a totally different category that's auditory hallucinations very different than tinnitus tinnitus is very common we all are going to get tinnitus at some point because of degenerative changes in the ear loss of hearing etc but there are disorders and diseases that can cause tinnitus menieres as we talked about is one of them an acoustic neuroma for instance that's a tumor of the hearing and balanced nerve it could just present itself with tinnitus mild just a ringing or a buzzing or a noise in the ear people ignore it even physicians ignore it eventually loss of hearing eventually one recognizes that there's a tumor growing there so tinnitus or hearing loss should not be ignored vertigo cannot be ignored because it really makes you sick but tinnitus and hearing loss people tend to ignore because you know i'm getting older you know i don't want a hearing aid but the most important thing is find out why find a diagnosis the discussion of what to do about it comes next we spoke about how sometimes dizziness and imbalance get confused with vertigo are there other diagnoses which cause similar symptoms that could be misdiagnosed as tinnitus a tinnitus also is a symptom so um when you have tinnitus it means something is wrong with your auditory system it could be a brain tumor it could be wax in your ear canal it could be fluid behind your eardrum so there's there are a lot of things that could cause tinnitus some of them mild and reversible and some of them are chronic uh the garden variety tennis that i talk about you know from aging and so on that's common benign it's very annoying uh unfortunately today that kind of tinnitus still has no cure and it's very frustrating to people who say you know i hear the sound in my ear i wish it could be quiet and there is no final definitive treatment for it but we're doing research on this and right now we are running a research protocol of a medicine that we are injecting in the ear to hopefully stop that type of tinnitus so you know stay tuned there's research on tinnitus going on everywhere and hopefully we will find a cure someday so if a patient presents with tinnitus what kind of testing is necessary and what could a patient expect they would initially be tested for to rule things out because you said there are so many things that can cause it anytime you walk into a physician's office there's something called the history which means i will ask you questions about when and how and how often that's called the history from that history we're going to decide we're going to do the physical exam looking at the ear is going to give us a lot of information is there wax impaction is there inflammation is there infection is there fluid behind the eardrum is there a hole in the eardrum all of these things can be seen just with a simple physical exam after the physical exam comes the testing and the main test is the audiogram audiogram is when we put you in a booth and we're going to be presenting you with with sounds and beeps and tones and words and check your hearing level and your level of speech recognition because loss of hearing comes in two flavors a loss of volume which means giving you more volume you can hear and understand or loss and volume and speech discrimination which means even though you hear something louder you still don't understand what the word or the sentence is so we test for those after the audiogram is something called the auditory brainstem response audiometry that's like in the ekg the electrocardiogram for the ear it's going to measure the electrical impulses from the ear as they travel through the hearing nerve into the brain and a test called electrococcography checks those same electrical impulses within the cochlea within the inner ear so all of these steps are to tell us what is the status of the hearing system of the auditory system from the outer ear up into the brain how common is the tinnitus because you said there's the garden variety everyone gets it at some point as they age but how common is more severe tinnitus like you're talking about where further testing is needed and treatment as well you know testing is needed at all grades of tinnitus because because you want to diagnose a condition early not late so i would not wait until the tinnitus is severe to get tested i would i would test it as soon as you recognize it uh treatment could be delayed if we say well this is a benign condition and we don't you know that you could live with it masking is a big way to control tinnitus masking means confuse your brain present your brain with other better things to hear music tv the fan the refrigerator anything that points away from your attention to the tinnitus is a good way to control your tinnitus when it's severe it has to be medicated and unfortunately sometimes it is very severe and we've had unfortunate people who have committed suicide because of tinnitus fortunately it is rare but if one is is getting there most importantly seek care we can help before you get to that level you spoke about the masking that that can be lifestyle choices is it similar lifetime style changes to vertigo that you spoke about before that you can also make to deal with some tinnitus stress for example uh is a big enhancer of tinnitus so we do cognitive therapy for tinnitus and cognitive therapy can be done by psychologists by therapists there are even programs on your iphone that could help you with masking and cognitive therapy for tinnitus so these are all lifestyle changes and brain over matter changes that could help people with tinnitus to cope with it now i know we need a whole another session to discuss the different kinds of implants that might be used and surgical procedures that sometimes are used for these patients experiencing vertigo and tinnitus but because we have a few minutes what are some of the most common ones that you present to patients or are good options the procedures for vertigo are different than the procedures for tinnitus if we are talking about meniere's disease for instance and we treat meniere's disease with procedures on the ear the simplest procedure on the ear is uh using steroids that are injected or placed in the ear through a mechanism called a microwave mechanism the patient's places drops in their ear we had already placed a wick in the ear canal that transports those steroids towards the inner ear if their their meniere's is steroid uh responsive then that enhances the hearing decreases the tinnitus and decreases the vertigo spells patients who do not respond to that then they could have more invasive therapy there's a procedure called the vestibular neurectomy which we do successfully here uh that stops the vertigo and preserves the hearing office procedure-wise there's something called gentamycin treatment gentamicin is an antibiotic that is used because of its toxic effect on the ear so gentamicin is placed in the ear to kill the cells in the inner ear that are causing the vertigo so it's not used as an antibiotic it's used as for its side effect and that can help the patient avoid going into the operating room for the real procedure i think what we're hearing here today is that there really are so many options for both vertigo and tinnitus and patients shouldn't suffer when when it comes to having vertigo or tinnitus or or both they really should seek care sooner rather than later that is true that is true and they seek they should seek care with specialists who handle those situations and you know unfortunately um people could get wrong advice because of misinformation uh and as i said uh the people who have tinnitus and don't care for it because they were told you're just getting old uh that's bad advice uh the people who are told you have meniere's disease there's nothing we could do go and live with it that's bad advice and that is that is advice that's given by health care providers so it the the problem is not only at the patient level the problem is education at the health care provider level and that's why sometimes specialist care is a better option dr jack wassen thank you so much for joining us for this discussion today my pleasure and as a reminder we always encourage everyone in our community to visit smh.com to get the latest information from sarasota memorial have a great day

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